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Pharmacy-led initiative for improving peri-operative medication reconciliation among bariatric surgical patients: what is the role?

  • 2020 SAGES Poster
  • Published:
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Abstract

Background

Multiple medication changes are common after bariatric surgery, but pharmacist assistance in this setting is not well described. This study evaluated the feasibility and effectiveness of a pharmacy-led initiative for facilitating discharge medicine reconciliation after bariatric surgery.

Methods

A standardized post-operative pharmacy consult evaluation was conducted on bariatric surgery inpatients at a single academic center starting 1/2/2019. Retrospective chart review evaluated patient characteristics, medication changes, and 30-day outcomes pre-intervention (7/2018–12/2018) and post-intervention (1/2019–12/2019). Two-sample t tests or binomial tests were used for continuous or categorical variables, respectively; a p-value of < 0.05 was deemed statistically significant.

Results

A total of 353 patients were identified for study inclusion (n = 158 pre-intervention, n = 195 post-intervention) with a mean age of 45 years, 87% female, and 71% sleeve gastrectomy. Overall pharmacy consultation compliance was 94% with 77.0% of home medication recommendations followed. Non-narcotic pain medication prescription use significantly increased (39% pre- vs. 54% post-intervention; p < 0.001). At discharge, the average number of changed or new medications significantly increased (3.7 ± 1.2 pre- vs. 4.2 ± 1.8 post-intervention; p = 0.003) while the average number of stopped medications was similar (1.2 ± 1.5 pre- vs. 1.5 ± 1.9 post-intervention; p = 0.09). Anti-hypertensive medications were decreased or stopped substantially more often with pharmacist input (44.7% pre- vs. 85.4% post-intervention; p < 0.001). Three medication-related readmissions happened pre-intervention with none post-intervention. Outpatient medication-related phone calls did considerably increase (31% pre- vs. 39% post-intervention; p = 0.04), while overall 30-day readmissions significantly decreased (7.6% pre- vs. 1.5% post-intervention; p = 0.04).

Conclusions

Inpatient pharmacy consultation facilitated rapid alteration to more appropriate therapy for hypertension management and significantly increased use of non-narcotic pain medications upon discharge among bariatric surgery patients. Improved protocol adherence is anticipated with program maturity and patient education interventions will be deployed to address outpatient phone calls.

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Acknowledgements

The authors are grateful to Daryl Todd, Clinical Nurse Specialist, for his incredible work and efforts to create and promote the standardized post-operative pharmacy consult process. The authors would also like to thank Melissa Majumdar, Bariatric Coordinator, for her efforts to help implement the standardized medication education fact sheet as well as ongoing support and communication with the pharmacy, surgical, and nursing staff to ensure successful completion of the pharmacotherapy consult initiative.

Funding

None.

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Authors and Affiliations

  1. Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine, Room B206, 1364 Clifton Road NE, Atlanta, GA, 30322, USA

    Elissa A. Falconer, DeAngelo A. Harris, Arvinpal Singh, S. Scott Davis Jr., Edward Lin, Jyotirmay Sharma, Jonathan Pollock & Elizabeth M. Hechenbleikner

  2. Clinical Pharmacy, Emory Healthcare, Atlanta, GA, USA

    Amanda Van Prooyen & Jessica Hicks

  3. Division of General and General Surgery, Department of Surgery, Atlanta VA Healthcare System, Decatur, GA, USA

    Jonathan Pollock

  4. Statistical Engineering Division, Information Technology Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA

    Daniel V. Samarov

Authors
  1. Elissa A. Falconer
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  2. DeAngelo A. Harris
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  3. Amanda Van Prooyen
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  4. Jessica Hicks
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  5. Arvinpal Singh
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  6. S. Scott Davis Jr.
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  7. Edward Lin
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  8. Jyotirmay Sharma
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  9. Jonathan Pollock
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  10. Daniel V. Samarov
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  11. Elizabeth M. Hechenbleikner
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Corresponding author

Correspondence to Elissa A. Falconer.

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Disclosures

Drs. Falconer, Harris, Van Pooyan, Hicks, Singh, Davis, Lin, Sharma, Pollock, Samara, and Hechenbleikner have no conflicts of interest or financial ties to disclose.

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Falconer, E.A., Harris, D.A., Van Prooyen, A. et al. Pharmacy-led initiative for improving peri-operative medication reconciliation among bariatric surgical patients: what is the role?. Surg Endosc 36, 1593–1600 (2022). https://doi.org/10.1007/s00464-021-08343-y

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